iliac artery aneurysms types and treatment › media › 0800_klaus_mathias...rupture occurred in...
TRANSCRIPT
LINC 2018
K. Mathias
Interventional Radiologist and Neuroradiologist
Hamburg - Germany
Iliac Artery Aneurysms
Types and Treatment
Locations ...
• Common Iliac Artery
• Internal Iliac Artery
• External Iliac Artery
Solitary
Combined
Aneurysm Types
Single
Multiple
Concentric
The type influences the treatment choice
Aneurysm Types
Single
Multiple
Concentric
Excentric
The type influences the treatment choice
Pathogenesis
• Atherosclerosis
• Collagen diseases
• Inflammatory diseases
• Trauma
• Post-operative anastomotic
aneurysm
TX Indications depend on ...
• Symptoms
• Size
Compression
Pain
Rupture with bleeding and shock
2.5 – 3.0 x normal diameter
TX Options
• EVAR
• Covered stent
• Amplatzer Plugs
• Coils
• Particle + fluid embolization
CIA Aneurysm
J. H. m-76
Excentric CIA Aneurysm
W. St. m-74
Excentric CIA Aneurysm
W. St. m-74 EVAR with Z-BIS
CIA Aneurysm
The expansion rate of CIAAs is 0.29 cm/y
J Vasc Surg 2008;47:1203-11
Hypertension predicts faster expansion
Elective repair of asymptomatic patients with CIAA >3.5 cm is justified, because no rupture of a CIAA <3.8 cm was observed.
E. F. m-78
Combined AAA and CIA Aneurysm
AAA + CIA Aneurysm
D. Sch. m-69
AAA + CIA Aneurysm
D. Sch. m-69
AAA + CIA Aneurysm
D. Sch. m-69 EVAR
Anastomotic Aneurysm
K.B. m-63 Aorto-biiliac prothesis 6y ago
Anastomotic Aneurysm
H. K. m-83 14y after surgical AAA repair
Anastomotic Aneurysm
H. K. m-83 EVAR 14y after surgical AAA repair
CIA Aneurysm 11Y after Surgery
J. S. m-77 Covered stent
Rupture occurred in 38% with a
mortality of 58%.
Brin B, Busuttil R. Isolated hypogastric artery aneurysms. Arch Surg 1982;117:1329–1333.
There was no direct relationship
between the size of the aneurysm and
the risk of rupture.
Risk of IIA Aneurysms …
IIA Aneurysm
E. K. m-77 Embolization + Covered Stent
IIA Aneurysm
D. K. m-69
I.H. f-80 Bladder Cancer
I.H. f-80 Bladder Cancer
Tumor Erosion of IIA
I.H. f-80 Bladder cancer
After embolization of IIA
Tumor Erosion
I.H. f-80 Bladder cancer
Traumatic Aneurysm ...
A. G. f-18
Traumatic IIA Aneurysm ...
A. G. f-18
Covered stent EIA
Amplatzer plug IIA
False Postraumatic EIA Aneurysm
E.W. f-75
Covered stent
Take home message …
Diagnosis with US, CTA and MRA
Treatment planning best with CTA
Most aneurysms can be treated with
endovascular means
Mycotic aneurysms must be resected